The association between blood pressure and long-term outcomes of patients with ischaemic cardiomyopathy with and without surgical revascularization: an analysis of the STICH trial

被引:15
作者
Andersson, Bert [1 ]
She, Lilin [2 ]
Tan, Ru-San [3 ]
Jeemon, Panniyammakal [4 ,5 ]
Mokrzycki, Krzysztof [6 ]
Siepe, Matthias [7 ]
Romanov, Alexander [8 ,9 ]
Favaloro, Liliana E. [10 ]
Djokovic, Ljubomir T. [11 ]
Raju, P. Krishnam [12 ]
Betlejewski, Piotr [13 ]
Racine, Normand [14 ]
Ostrzycki, Adam [15 ]
Nawarawong, Weerachai [16 ]
Das, Siuli [17 ]
Rouleau, Jean L. [14 ]
Sopko, George [18 ]
Lee, Kerry L. [2 ,19 ]
Velazquez, Eric J. [2 ,20 ]
Panza, Julio A. [21 ,22 ]
机构
[1] Sahlgrens Univ Hosp, Dept Cardiol, Bla Straket 3, SE-41345 Gothenburg, Sweden
[2] Dukc Clin Res Inst, 2400 Pratt St, Durham, NC 27705 USA
[3] Natl Heart Ctr, 5 Hosp Dr, Singapore 169609, Singapore
[4] Sree Chitra Tirunal Inst Med Sci & Technol, Achutha Menon Ctr Hlth Sci Studies, Trivandrum 695011, Kerala, India
[5] Ctr Chron Dis Control, New Delhi 110016, India
[6] Pomeranian Med Univ, Dept Cardiac Surg, SPSK 2,Powstancow Wielkopolskich 72, PL-70111 Szczecin, Poland
[7] Univ Herzzentrum Freiburg Bad Krozingen, Klin Herz & Gefasschirurg, Sudring 15, D-79189 Bad Krozingen, Germany
[8] State Res Inst Circulat Pathol, Arrhythmia Dept, Rechkunovskaya 15, Novosibirsk 630055, Russia
[9] State Res Inst Circulat Pathol, Elecirophysiol Lab, Rechkunovskaya 15, Novosibirsk 630055, Russia
[10] Hosp Univ Fdn Favaloro, Av Belgrano 1782,C1093AAS, Buenos Aires, DF, Argentina
[11] Dedinje Cardiovasc Inst, Heroja Milana Tepica Br 1, Belgrade 11040, Serbia
[12] Care Hosp, Care Ctr, Rd 10,Banjara Hills, Hyderabad 500034, Telangana, India
[13] Inst Kardiol, Klin Kardiochirurg, Wilenska 44, PL-80215 Gdansk, Poland
[14] Univ Montreal, Montreal Heart Inst, 5000 Belanger Est, Montreal, PQ H1T 1C8, Canada
[15] Natl Inst Cardiol, Alpejska 42, PL-04628 Warsaw, Poland
[16] Chiang Mai Univ, Dept Surg, Chiang Mai 50200, Thailand
[17] Ctr Chron Dis Conrol, C1-52 2nd Floor, New Delhi 110016, India
[18] NHLBI, NIH, Bldg 10, Bethesda, MD 20892 USA
[19] Duke Univ, Dept Biostat & Bioinformat, Sch Med, Durham, NC 27708 USA
[20] Yale Sch Med, Dept Internal Med, Sect Cardiovasc Med, POB 208017, New Haven, CT 06520 USA
[21] New York Med Coll, Westchester Med Ctr, Cardiol, 100 Woods Rd,Macy Pavil,Room 100, Valhalla, NY 10595 USA
[22] New York Med Coll, WMC Hlth Network, 100 Woods Rd,Macy Pavil,Room 100, Valhalla, NY 10595 USA
基金
美国国家卫生研究院;
关键词
Heart failure; Coronary artery disease; Hypertension; Blood pressure; Coronary artery by-pass grafting; Survival; Surgery; ACUTE CORONARY SYNDROMES; HEART-FAILURE; MYOCARDIAL-INFARCTION; BYPASS SURGERY; J-CURVE; MORTALITY; HYPERTENSION; GUIDELINES; DIAGNOSIS; DISEASE;
D O I
10.1093/eurheartj/ehy438
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Hypertension (HTN) is a well-known contributor to cardiovascular disease, including heart failure (HF) and coronary artery disease, and is the leading risk factor for premature death world-wide. A J- or U-shaped relationship has been suggested between blood pressure (BP) and clinical outcomes in different studies. However, there is little information about the significance of BP on the outcomes of patients with coronary artery disease and left ventricular dysfunction. This study aimed to determine the relationship between BP and mortality outcomes in patients with ischaemic cardiomyopathy. Methods and results The influence of BP during a median follow-up of 9.8 years was studied in a total of 1212 patients with ejection fraction <= 35% and coronary disease amenable to coronary artery bypass grafting (CABG) who were randomized to CABG or medical therapy alone (MED) in the STICH (Surgical Treatment for Ischaemic Heart Failure) trial. Landmark analyses were performed starting at 1, 2, 3, 4, and 5 years after randomization, in which previous systolic BP values were averaged and related to subsequent mortality through the end of follow-up with a median of 9.8 years. Neither a previous history of HTN nor baseline BP had any significant influence on long-term mortality outcomes, nor did they have a significant interaction with MED or CABG treatment. The landmark analyses showed a progressive U-shaped relationship that became strongest at 5 years (chi(2) and P-values: 7.08, P = 0.069; 8.72, P = 0.033; 9.86; P = 0.020; 8.31, P = 0.040; 14.52, P = 0.002; at 1, 2, 3, 4, and 5-year landmark analyses, respectively). The relationship between diastolic BP (DBP) and outcomes was similar. The most favourable outcomes were observed in the SBP range 120-130, and DBP 75-85 mmHg, whereas lower and higher BP were associated with worse outcomes. There were no differences in BP-lowering medications between groups. Conclusion A strong U-shaped relationship between BP and mortality outcomes was evident in ischaemic HF patients. The results imply that the optimal SBP might be in the range 120-130mmHg after intervention, and possibly be subject to pharmacologic action regarding high BP. Further, low BP was a marker of poor outcomes that might require other interactions and treatment strategies.
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页码:3464 / +
页数:9
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